Empyema thoracis; possible factors for predicting this complication in children with community acquired bacterial pneumonia

ABSTRACT

Empyema as a complication of community acquired pneumonia [CAP] is relatively common occurrence in developing countries. Prospective study. 4 year Jan 2001- Dec 2004. Department of Pediatric surgery the Children's hospital Lahore. A total of 114 cases of empyema thoracic secondary to CAP were dealt with during this period, while in the same duration a total of 1768 cases of pneumonia were treated at the Children's hospital Lahore. Majority of the patients with CAP [59.61%] were below one year of age whereas the patients who developed empyema, were mainly [45.67%] between 2 to 5 years of age. Patients above 5 years of age having CAP [31.70%] and having repeated attacks of respiratory tract infection were most susceptible to develop empyema. Staphylococcus aureus was the most common organism found [40.35%] in this series. Vaccination, poverty and gender did not significant affected the development of empyema among the patients of CAP. Antibiotic resistance had no role in the development of empyema. Ibuprofen may be a risk factor. All the patients were initially managed with tube thoracostomy and antibiotics. Forty-eight patients [42.10%] needed subsequently operative management. Three patients [2.63%] had fatal course in this series same as seen in patients of CAP [2%]. Immunization against causative organism and modification of out patient treatment may affect the incidence of empyema in children and should be studied prospectively